UK urges free basic health care in poor countriesBMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7556.1470-a (Published 22 June 2006) Cite this as: BMJ 2006;332:1470
The abolition of fees for basic health services in developing countries, as achieved in Uganda, will remove a major barrier to improvement in the health of people in these nations. And such initiatives should be supported by the countries themselves and international donors.
This is the belief of Hilary Benn, the United Kingdom's secretary of state for international development and head of the Department for International Development, which manages Britain's aid to poor countries. He was speaking at a debate at the London School of Hygiene and Tropical Medicine, London, and also launching the progress report on the UK's maternal health strategy.
Citing the work of Chris James, health financing consultant to Save the Children, and colleagues published in the BMJ last year (2005;331:747-9), Mr Benn said that more than 230 000 children's lives could be saved if fees for basic health services were abolished in 20 African countries.
He said that users in developing countries faced physical and financial barriers. In Ethiopia a third of all rural people have to walk more than 10 km to reach a health service and will have to pay once they get there. “It can't be right to take money from poor people when they are sick and when they can't afford it,” he said.
Mr Benn reported progress on removing user fees. “We have helped Uganda do this. Ending fees increased demand. This increased funding for more health workers and drugs, and so this helped increase supply,” he said.
Attendance at health facilities in Uganda has more than doubled, as have rates of immunisation rates, which are now more than 80%. The Department for International Development is helping Zambia remove its user fees. Other countries are also being helped or developing their own initiatives.
The maternal health strategy report states that overcoming financial barriers is being addressed in Bangladesh through a pilot voucher scheme funded by the Ministry of Finance there and in India through small scale financing initiatives.
The department is recommending that maternal mortality be used as an indicator of the broad effectiveness of a country's healthcare system. Pregnancy and childbirth kill a woman every minute in the developing world. The reduction of maternal mortality has been the most difficult of the United Nations' eight millennium development goals to reach, largely because it depends on people's access to basic public health services.
The UK is the first developed country to produce a progress report towards achieving the millennium development goal on maternal health. The target of this goal is to reduce the maternal mortality ratio (the number of deaths among mothers per 100 000 live births) by three quarters between 1990 and 2015. One of the indicators for the goal is the proportion of births attended by skilled health personnel. Mr Benn said that unaffordable user fees and the lack of long term investment in health systems are preventing many women from having skilled attendance during birth.
He said, “By providing developing countries with long term, predictable support for 10 year health plans, countries would be able to abolish user fees for basic health services if they wished to.”
DFID's Maternal Health Strategy—Reducing Maternal Deaths: Evidence and Action is available at www.dfid.gov.uk.